Individual
CLAY CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 609-2000
Mailing address
PO BOX 6210, FARMINGTON, NM 87499-6210
(505) 609-2258
(505) 609-2259
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
57227
NM
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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